Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
J Cereb Blood Flow Metab. 2020 Oct;40(10):1966-1974. doi: 10.1177/0271678X20918816. Epub 2020 May 19.
We previously demonstrated that in the DEFUSE 3 trial, the union of the baseline core and the 24-h Tmax > 6 s perfusion lesion predicts the infarct volume at 24 h. Presently, we assessed if collateral robustness measured by the hypoperfusion intensity ratio (HIR) and cerebral blood volume (CBV) index accounts for the variance in these predictions. DEFUSE 3 patients underwent MRI/CT perfusion imaging at baseline and 24 h post-randomization. We compared baseline and follow-up HIR and CBV index across subgroups stratified by differences between predicted and observed 24-h infarct volumes. Of 123 eligible patients, 34 with 24-h infarcts larger than predicted had less favorable collaterals at baseline (HIR 0.43 vs. 0.32, = 0.006; CBV Index 0.78 vs. 0.85, = 0.001) and 24 h (HIR 0.56 vs. 0.07, = 0.004; CBV Index 0.47 vs. 0.73, = 0.006) compared to 71 patients with more accurate infarct volume prediction. Eighteen patients with 24-h infarcts smaller than predicted had similar baseline collateral scores but more favorable 24-h CBV indices (0.81 vs. 0.73, = 0.040). Overall, patients with 24-h infarcts larger than predicted had evidence of less favorable baseline collaterals that fail within 24 h, while patients with 24-h infarcts smaller than predicted typically had favorable collaterals that persisted for 24 h.
我们之前的研究表明，在 DEFUSE 3 试验中，基线核心区与 24 小时 Tmax 超过 6 秒的灌注损伤区的联合可预测 24 小时的梗死体积。目前，我们评估了通过低灌注强度比（HIR）和脑血容量（CBV）指数测量的侧支循环的稳健性是否可以解释这些预测的差异。DEFUSE 3 患者在基线和随机分组后 24 小时接受 MRI/CT 灌注成像。我们比较了预测和观察到的 24 小时梗死体积之间存在差异的亚组的基线和随访 HIR 和 CBV 指数。在 123 名符合条件的患者中，34 名 24 小时梗死体积大于预测值的患者基线侧支循环较差（HIR 0.43 比 0.32， = 0.006；CBV 指数 0.78 比 0.85， = 0.001），24 小时时更差（HIR 0.56 比 0.07， = 0.004；CBV 指数 0.47 比 0.73， = 0.006）与 71 名梗死体积预测更准确的患者相比。18 名 24 小时梗死体积小于预测值的患者有相似的基线侧支循环评分，但 24 小时时更有利的 CBV 指数（0.81 比 0.73， = 0.040）。总的来说，24 小时梗死体积大于预测值的患者有证据表明基线侧支循环较差，这些侧支循环在 24 小时内失效，而 24 小时梗死体积小于预测值的患者通常有持续 24 小时的有利侧支循环。
